Auschwitz Reflections: ‘The Ramp’ – the Psychopathology of Decision

Author

Antoni Kępiński, PhD, 1918–1972, Professor of Psychiatry, Head of Chair of Psychiatry, Academy of Medicine in Kraków. Former prisoner in the Miranda de Ebro concentration camp (Spain).

One of the camp scenes long to be remembered by much of the world is, as well as crematorium chimneys and piles of dead prostrate bodies, a scene of the selection ‘on the ramp’. A crowd of women, men, old people, children; rich and poor, pretty and ugly, walking past an SS-doctor, their ruler and judge.

A small movement of his hand could decide whether the man that faced him would go to the gas chamber in a minute or whether he would be offered the chance to survive for several days or even months. There was something of the last judgement in this scene; a small movement of the hand could either lead to the fire or offer the possibility of survival. Those who were awaiting the sentence were usually not aware of their destiny. They only knew that the movement of the hand was very important in their life; that it denoted something they could not guess until the moment they saw a face with a gas mask in an opening of the alleged baths. Those prisoners who were aware what the selection meant tried to make one final effort and walk upright, and march energetically to make a good impression on the SS-doctor and be directed to his right.

One of the paradoxical features of camp life was the true ‘Nacht und Nebel’; the fact that, despite its overwhelming dullness, it was extremely expressive at the same time. Phenomena that would be unobtrusive in normal life, recognised as different subtle shades of reality and thus sometimes even difficult to notice, became dramatic to an unusual degree in the camp, and evoked both horror and admiration for human nature. Therefore, an analysis of camp life may be helpful in understanding many phenomena present in human life but frequently ignored because of subtlety and ambiguity. Certain analogies might be found in psychiatry that also deal with this area of phenomena connected with human life, but incomparably larger and thus easier to study. The fact that the camp experiences are graven on the memory of humanity also accounts for the unusual expressiveness of these experiences. Many former prisoners still suffer from nightmares about the camp, and scenes from camp life are easily brought back by their imagination.

Selection for the gas chamber at the Auschwitz-Birkenau concentration camp

A friendly gesture, word, or smile, so natural in everyday reality, could save a prisoner’s life, or bring his self-confidence back. States of depression and anxiety connected with everyday worries and frequent in the life of every human might be disastrous in camp. Those who did not want to live any longer, who could no longer stand the reality around them, very often did not wake up at all the next morning. Friendships made in the camp were so strong that they usually lasted longer than any other emotional relationships that originated in either the pre- or post-camp period. For those who managed to survive the camp, their camp mates will always be the closest and only people who can understand them. Positive and negative features of human nature, coexisting in every man and creating a complex picture of his character, acquired a special meaning of heroism, holiness and martyrdom or extreme brutality and degenerated cynicism. Many examples could be quoted to support this. Life on the border of death where one wrong movement, wrong decision, or simply a coincidence might lead to the extermination of a prisoner or force him to follow a path of brutal aggression where he became gradually deprived of his humanity, was largely responsible for the fact that human features and rights had such sharp outlines.

The problem of decisions made in the camp was similarly sharpened. The ‘ramp’ situation comprised three variants of human decisions. The first variant was that of a man who decided the fate of another man; the second of a man who knew what his destiny might be and decided to try and overcome his own fate; and the third of a man who did not know his fate, did not know to fight it and was forced by his doubts, fear and anxiety into random decisions that were often senseless.

These three variants are also frequently encountered in everyday life.

It would perhaps be easiest to imagine the situation of the one who passed the final sentence. At times, he may have felt like God at the Last Judgement but most often, he was probably bored and tired. He believed that his part was essential in the process of clearing away the dirty elements from his race; he was in a hurry and was already thinking of something else; after he finished his duties he usually celebrated, washed off all possible traces of remorse with alcohol. The movement of the hand responsible for someone else’s life or death was usually arbitrary; every tenth or twentieth prisoner might stay alive.

In normal life, it would be difficult to avoid situations in which one is obliged to make decisions about someone else’s life or where fate depends on decisions made by others. The range of authority and the level of social hierarchy are normally proportional to the importance of a decision that is to be made. The more people influenced by the decision and the greater its impact on their future lives, the greater the importance of the decision itself. Every decision that might be responsible for human fate is burdened with great responsibility. One might wonder whether we are at all entitled to take such responsibility.

Those who made decisions about human life on the ramp and who were most probably aware of their responsibility understood it as a responsibility to eliminate those who, in their estimation, were a disgrace to humanity. It should be assumed that they suffered from a pathological lack of imagination. Otherwise, they would never have been able to make the decisive movement so easily. Their actions were automatic: the more, and the quicker, the better.

The ramp at the former Auschwitz-Birkenau concentration camp. Photograph by Z.J. Ryn

Anyone may happen to make decisions about the fate of another human being. Such decisions are never easy, which is why it is helpful to have all sorts of norms that specify the type of the decision that should be made in given circumstances. For a judge such norms would be constituted by legal regulations, for a doctor his knowledge of diagnostics and prognosis and for a teacher, examination regulations. The more objective the decision is to be, the stronger the basis of norms and more limited subjective, especially emotional, elements should be. Thus, the decision no longer belongs to an individual but becomes normative, that is, should be identical regardless of who makes it, providing that the basis of norms is the same. In this sense, we can talk of blind justice. The most righteous man should not think of the person that will be influenced by his decision from an individual perspective, but from the perspective of the norms that he represents. Following such reasoning, we could arrive at the absurd conclusion that in the situation on the ramp, an SS-doctor was a most just person, acting according to the norms imposed on him by his superiors: the strongest prisoners should work in the camp, all the others should go to gas chamber; he excluded all the subjective elements of his decision, especially those of an emotional nature, and his decisions were automatic. The absurdity of such a conclusion lies in the fact that no man is able to make completely just decisions, and thus can never ‘close his eyes’ and make blind decisions, as the mythological Themis did. When one makes decisions about another’s fate, it is not enough to follow the norms: one must ‘see’ the man, imagine his past, present and future situation. All the psychological actions connected with such decisions must be made with great emotional involvement. Every teacher, doctor, or judge – that is, people whose professions predispose them to make decisions about the fate of others – are well acquainted with this simple fact. Even the most complex computer could not replace them and make the decisions they make. The situation of an SS- doctor selecting prisoners may serve as an example of the importance of the emotional factor in making all decisions, especially ones concerning the fate of other people. The most important environment for every man is composed of other people around him; therefore, all decisions that concern those people are the most important and made with the greatest emotional involvement. A basic emotional decision made about another man is the decision whether to approach him or to keep away from him. Excluding the different emotional shades of the alternatives, both of them may be specified based on sympathy or total ignorance. For the SS-doctor making the selection, Jews were repulsive or totally indifferent at best, such were the ideas and attitudes imparted to him. He was not able to see the human being in them, they did not interest him at all unless they could constitute objects of his scientific research or plunder; he certainly never thought of approaching them, exchanging remarks, asking about their experiences. The element of emotional detachment is essential in all war propaganda; contact with the enemy is reduced to a minimum and the enemy is always portrayed from the worst possible perspective. In a close emotional relationship between two people, when they lose their emotional contact they cease to understand each other and no longer have any mutual interest in their relationship, and it usually breaks up.

Doctors who were prisoners at the same time also had to decide about other prisoners’ death, and although such decisions would have been very difficult for them, they could not avoid them; they did not have enough medicine to save everybody’s life, and they could not save all the prisoners from selection. They had to decide who should be left to die and who should be given the chance to survive. One might again arrive at an absurd analogy between their way of making decisions and the way that SS-doctors made their decisions. The absurdity of this analogy results from the fact that the difference in emotional attitudes in both cases is not taken into consideration. Doctors who were prisoners wanted to help the sick and they had to allow them to die against their own will. For SS-doctors, the diseased were foreign or neutral elements that eventually would have to be eliminated.

The selection process

A technical approach to another human being is encouraged by the faster and faster changes in our natural environment, resulting from the technological progress of our age. It is increasingly difficult to perceive human characteristics as the factors connected with effective activity of a technological-social mechanism become increasingly important. Such an approach may constitute one of the greatest dangers of civilisation. The SS-doctor on the ramp, who represents such an attitude, should become a warning to all of us.

The second variant includes a relatively small group of prisoners who were aware of the significance of the hand movement made by the SS- doctor. Many of them had already reached a state of such prostration that they were indifferent to the future awaiting them; they were not able to make any decisions at all, let alone to make the great effort to assume the posture of a healthy and strong man when they were totally exhausted musulmen. There were also prisoners, however, for whom the decision to survive was stronger than prostration, illness, exhaustion, and apathy. They managed to make an effort and use all their willpower to walk upright in front of the SS- doctor. Even children tried to walk on tiptoe to touch a measuring stick with their heads, because they knew this meant life or death.

Such a great effort was not always rewarded, since it was also a question of pure chance and the mood of the ‘judge’ whether a prisoner was directed to the gas chamber or was allowed to live. Such prisoners still accepted the examination rules; they attempted to look the way the Nazis wanted them to, that is, they tried to look like ‘numbers’, able to perform manual work. According to the regime, everyone was to be healthy and strong until he was completely exhausted, and then died. The ‘number’ was supposed to work efficiently until the end: the German sense of order could not tolerate living numbers that were not able to work for the Third Reich.

The first essential necessity of camp life was to accept the model of behaviour created by those who invented the idea of the concentration camp. The ‘ceremony’ of introducing a prisoner into the camp aimed at stamping out any other models as soon as possible, and initiated a prisoner into the camp model. The idea of this ‘ceremony’ was not invented by the creators of the concentration camp: it also exists, though not in such a drastic form, in various social institutions, especially when it is essential to initiate the members very quickly into the norms existing in a given institution. To this end, previous models of behaviour must be eliminated, especially those that would be inconsistent with the new ones, and at the same time new models should be imposed upon the new members. A typical example may be provided by the recruitment period in the army. Difficult periods of trial are naturally encountered, and not only in the army. The same happens at a new place of work, in a new environment at school, outside school, etc. We often have to learn new things through bitter experience when we have to join a different social group. The more difficult the trial period, the stricter the norms observed in the group. With the course of time, new norms of behaviour become automatic; they no longer require any special consideration, that is, it is no longer necessary to decide whether to accept them or not and to what extent they should be accepted. Before such a period, however, it is sometimes necessary to spend a long time learning the norms. A recruit learns to salute – he cannot do it perfectly at first, but later salutes automatically without thinking of it, with minimal effort.

When the new norms of behaviour are accepted and observed, it does not necessarily mean that they are also accepted ‘internally’. A soldier may skilfully salute his officer without the respect that should serve as the background to a salute. Conformity is the appropriate term that denotes adjustment to certain norms without their internal acceptance. Despite the fact that one behaves against one’s own will, that the decision was made for a person, one is able to perform actions as if they resulted from one’s own decisions. Rebellion against the imposed norms can never be too strong, and over the course of time, it must become increasingly weaker, otherwise it would deprive a new member of the possibility to learn and act according to the new norms. Hypnosis is an example of a situation where the range of the will of one person is wider than that of another. Under the influence of a hypnotist, a hypnotised person can perform actions that he would normally never be able to perform, for instance, to increase the muscle tension to such a degree that the whole body is stiffened; to control the vegetative system so that the heart action can be slowed down or accelerated at will; to contract blood vessels, etc. The perception of pain can also be changed: the patient does not feel pain, does not hear or see at all, or does not hear and see the things specified by the hypnotist. Memory records, such as recollections from very early childhood, etc., can be activated which normally would not be possible. However, the hypnotist is not able to impose anything that would be contradictory to his patient’s will: for instance, he cannot make the patient commit murder or suicide.

In the camp, the majority of prisoners did not accept the imposed norms of life there. The exception were those who wanted to imitate their camp superiors, adapt their way of thinking and, as usually happens with neophytes, were more eager than the Germans. Initially the prisoners were shocked with the camp model of life; the initial ‘ceremony’ was very important. In a state of shock, it was easier to act automatically, behave according to the camp regime, and forget about previous habits. After some time they were indifferent to the sights that initially caused horror or disgust, and they also become indifferent to their own pain and misery. Many activities performed in the camp became automatic; prisoners automatically stood upright and took off their caps at the sight of SS-men, they automatically took their places at roll calls, went to work, etc. Automation was an absolute necessity. Prisoners were not supposed to think or wonder whether to do or not what they were asked or how to do it; they were supposed to perform actions immediately as well as they could and if they didn’t they were beaten or killed.

The situation on the ramp was a kind of examination of every person whether he was able to perform the functions of a concentration camp prisoner, or whether he was only good enough for the gas chamber and should be killed on the spot. Therefore, people made the maximum effort and tried to make as good an impression as possible. An examination situation can be met in every institution and every institution selects its members. Those who are unable to perform their duties properly are excluded from the institution. In the camp situation, exclusion was synonymous with death.

Death was an everyday reality of the camp and this awareness forced the prisoners to make quick decisions; they did not have time to think which way to choose, they did not have time to wonder which was right and which was wrong. They had to act quickly, as hesitation might end in death. They could afford no mistakes; the wrong decision might bring death. A similar situation is that of a soldier during a war; he cannot think or hesitate; the majority of decisions are made automatically; his consciousness does not participate in them.

The menace of death can change the perspective of time for human life. Normally, the future extends without limits. Even in the case of old and seriously ill people who do not have much time to live, the fact of death is not very clear in their consciousness; they still have some free future space in front of them. That allows them to move freely, and leaves them with the possibility to choose between different forms of activity. They can be wrong since there is still time to put everything straight, there is still time to hesitate, and to make conscious decisions.

In a situation of danger, the perspective of time is changed. The future is limited and thus becomes extremely important and intense. The awareness of death makes all decisions very significant; wrong decisions may bring death, right ones may help to avoid it. All other decisions that are not directly connected with the fight for life become redundant. Different forms of behaviour are also reduced to basic ones, connected with the fight for life. Everything that previously provided the meaning of existence and determined previous acts of will is excluded as unimportant. Nobody worries anymore about things that used to give him many headaches. Difficulties one had in making decisions in everyday life appear ridiculous in comparison with the importance of decisions in situations of imminent danger. All the decisions in such a situation must be very quick, there is no time to hesitate and ponder over arguments for and against. Decisions are frequently made impulsively. Only when the danger is over does a reflection come as to why one acted in such, and not another, way. Normally one would not be able to make such quick decisions and choose such appropriate ways of behaviour; and one cannot remember any wrong movements, as these would all have ended with death. Despite the fact that behaviour in a situation of imminent danger is not a fully conscious act, but rather a reflex and automatic series of movements, responsibility is still felt for everything done, and such is the attitude of those around us. Further, such situations are often regarded to be a true examination of our human values.

Is such an attitude correct? We are inherently convinced that an extreme situation can provide the best test for our humanity; such a conviction, however, cannot be supported by logical arguments. Why should a decision made without any time to hesitate, to think over all possible alternatives, a decision that is sometimes made at a sudden moment of reservation, be regarded as the most essential and representative of our human character? Hence another question: do we have any right to judge decisions made in extreme situations, when they are deprived of their most essential attribute of conscious thinking, made without hesitation, and the possibility of careful consideration of the right alternative?

Such a contradiction between our internal conviction and logical thinking results from the assumption that a decision is tantamount to a cognition and that volition is the truest manifestation of our psychological life, responsible for all forms of our behaviour. The basis of the above assumption is probably constituted by the Cartesian model of man, maximally dualistic, in which the human body is a mechanism controlled by the consciousness. A cognition is an order sent to this mechanism from the consciousness, and as such it must represent the quintessence of psychological life; it cannot be identified with anything impulsive, impetuous, non-deliberate.

Our attitude towards the living world and towards man is formed, to a great extent, by technological models. For man it is easiest to understand things that he himself has created. A mechanical model underpins the belief that all living organisms are nothing more but complex mechanisms. Such an attitude always helped in medical examinations. Any mechanism can be controlled at will, and can be analysed as a structure of different parts, which is an essential condition of a scientific approach. A mechanical attitude conditioned the development of scientific medicine. No mechanism, however, can act on its own, it requires some motive force with which to control it. If we assume the existence of the soul, we must burden it with the duty to control. Since only humans possess souls, it is only they who have free will; animals do not have souls, but behave as automatic mechanisms reacting to certain specified stimuli. On this basis, mentally ill people are deprived of free will since their souls are ill. Advocates of a dualistic view have problems with the explanation of the way in which psychological elements meet somatic elements, and where the borderline between them is situated. For Descartes, the pineal gland played the part of a switch between psychological and somatic elements. If the existence of the soul is rejected, the problem of free will is also eliminated. The basis becomes pure determinism. The laws of nature also refer to man; he is limited by them, deprived of the possibility to make any free choice. At the end of the 19th century, an optimistic view prevailed that even such a complex mechanism as man can be satisfactorily explained by movement of elementary particles, that is, in terms of physics and chemistry. This view played an important part in medicine; the significant development of biochemistry owes a lot to this, and therapy is still based on the assumption that every problem can be solved in a chemical way.

Selection for the gas chamber at the Auschwitz-Birkenau concentration camp

The development of a new technological model based on self-steering mechanisms dates back to World War II. The term itself suggests that the problem of control and decision-making (the problem of conation from the psychological perspective), so difficult for researchers of nature operating with a mechanical model, was now solved in a technological way. The steering mechanism of the barrel in an anti-aircraft gun makes its own decisions about where to point the barrel and when to fire bullets. Anybody who has had the opportunity to shoot knows that the act of pulling the trigger is connected with some hesitation and tension, which is necessary to choose the best moment to aim properly. In the case of skilful shooters, the decision about the proper moment is made faster; it happens that best shots are made automatically. A complicated process of decision-making, sometimes regarded as the most essential element of psychological activities, may be frequently performed better by a machine. This, however, means neither that electronic equipment possesses a soul nor that electronic equipment can replace psychological life. The fact that electronic mechanisms are capable of performing some activities previously regarded as exclusively human, such as logical thinking and decision-making, forces us to revise the notion of consciousness. It can no longer be identified with any specific function such as, for instance, a cognition. Similarly, we have not arrived at a satisfactory definition of life yet; we have defined neither a subjective manifestation of life nor the notions of soul or consciousness.

Self-steering mechanisms have the ability to make decisions based on three factors – programming a purpose; ability to receive information from the environment, especially those pieces of information that condition the effects of the activities performed by a mechanism (feedback); and memory. All those three factors contribute to the decision-making that can result in an alternative form (yes or no answers) as happens in the case of digital computers, or a continuous form (modulation of an answer) as in the case of analog computers.

Cybernetic models help us to understand brain activities. Cybernetics was based on the results of neuro-physiological research, as Lorente de Nó’s scheme of cerebral cortex combinations assisted in the construction of self-steering mechanisms. The morphological structure of the neurone itself points to the fact that a decision of some kind has already been made inside the neurone. It can receive signals from the environment with its numerous appendices (dendrites) – the signals reach the cell through so- called axosomatic synapses – and the signals leave the cell through only one channel (axon). Hence, the assumption that the integration of received signals and the decision of what signals should be sent back to the environment must take place inside the cell.

The structure of the combination of neurones makes it possible for some signals sent by a neurone to go back to the same neurone (so-called closed circuits). In such a way, the principle of feedback is realised. A neurone is informed of the effects of its own action. The signals that are received are recorded. According to Hyden’s hypothesis, the memory mechanism is based on the transformation of DNA and RNA structures under the influence of the flow of impulses coming to a neurone. The hypothesis is tempting since it connects phylogenetic (hereditary) and ontogenetic memory by means of identical biochemical mechanisms. A programmed purpose in a nervous cell would thus be its genetic substance (DNA) which, if the Hyden’s hypothesis proves to be correct, would be modified as the result of neurone cell activity.

Thus, a neurone meets the requirements for self-steering mechanisms to make decisions. Moreover, as happens in self-steering mechanisms, the decision may be an ‘either/or’ type, or a quantitative type. In the first case there is a complete discharge of the whole nervous cell (the so-called action potential), the value of which is independent of the strength of the stimulus attacking the cell or of the lack of such discharge. As in the case of computers, a binary system is used here (1 – discharge, 0 – lack of discharge). In the latter case, a local change of electric potential, a so-called local reaction, can be observed; it does not affect the whole cell and is proportional to the strength of the stimulus.

In a system of various types of combination, in the network of countless millions of neurones a hierarchy exists, which suggests that the decisions made by specific neurone cells are independent. Some groups of cells constitute ‘working complexes’ dealing with specific problems (the so- called nervous centres). A decision that reaches such a group of neurones has a global character; it does not deal with the details of performance.

The selection ramp at the Auschwitz-Birkenau concentration camp

The hierarchy of decision is connected with the problem of selection. Not all pieces of information can reach a higher level; some of them have to be eliminated. The selection is conditioned by the importance of a given piece of the whole organism. The problem of selection is so distinct that it may be exhibited by means of anatomic examination. For instance, the human retina consists of six million cones and 110 million rods, whereas the optic nerve has only one million fibres.

According to Wash (1966), ‘the retina aims at catching elements with a potential biological importance and eliminating the remaining ones’. The opposite situation can be observed when a flow of information is aimed at a circuit: an ‘authoritative’ decision is copied if its executor (the effector) is not very important, and a decision becomes more individual if the effector is more significant. A classic example might be provided by a colour motor field. A colour representation of an arm, lips, or tongue is much greater than that of the trunk or leg muscles. Therefore, a homunculus illustrating a cortical representation looks grotesque. Its grotesqueness results from the lack of equality between individual executive units; trunk muscles are nothing more than plebes in comparison with arm or tongue muscles. The distortion of anatomic relation in colour representation is much smaller in the case of animals; the level of significance of individual effectors is more uniform there. In the process of evolution, the hand and the motor mechanism of speech became an essential channel through which man could influence the surrounding world and hence the significance of these motor elements is much greater than the significance of the remaining parts of the motor apparatus. In animals, however, the equilibrium between different effector elements is clearer. The scale of significance is also binding in terms of signals entering the nervous system, as it constitutes a basis for selection. Consequently, the surrounding world is distorted; we can see the things that are important for us.

In neurasthenic syndromes of both organic and psychogenic origin, the symptom is manifested in the distortions of the hierarchy of nervous system activities and, at the same time, in distortions during the selection. Insignificant signals, that are usually suppressed, activate the nervous system along with signals that are significant. The result is chaos (‘buzz’ in cybernetic jargon) that can be compared to the red tape when the superior authority wants to know everything and make all the decisions: the obvious result is that they know nothing and make no decisions. The opposite situation can be observed in a hysterical conversion; some functional systems are excluded from the general hierarchy of the nervous system and acquire an artificial autonomy, with the clinical manifestation of paralysis or excessive activity. In social systems, an analogical autonomy can be observed when the governing authorities, whose interests are contradictory to the interests of subordinated individuals, artificially integrate the lives of these individuals; various opposition systems are then created which allow for the manifestation of all the tendencies suppressed by the official authorities.

The third characteristic feature of nervous system activities that takes part in decision-making, besides hierarchy and selection, is collectivity. Despite the fact that an individual neurone makes decisions, such decisions would not bear great significance if they were not supported by the decision made by other neurones. Every decision made by an individual neurone, in turn, is coordinated by the decisions of other neurones; according to the signals sent, a neurone may produce a yes/no answer (functional potential) or may limit the answer to a local reaction only. Local reactions activating only part of a nervous cell prepare it to give a final yes/no answer. Despite the correlation of neurones and the collective character of their work, they maintain their individuality; each of them has a specific pace of work that assists in decision-making: alternative (yes/no) or quantitative (local reaction). The quanta of a decision, that is, the decision of individual neurones, combine to form group decisions. Some groups of neurones combine their tasks and, consequently, also their decisions. A hierarchy and specialisation is produced. There are groups that are subordinate in relation to other groups and the result is a chain of relations. A single signal is enough to activate the whole course of events.

The problem of epilepsy appears to consist in the destruction of the system of interrelation and collective work of neurones. A group of nervous cells starts to discharge at its own pace independent of the activities of other neurones. The pace is gradually assumed by other nervous cells with the result of a general epileptic discharge. We may compare the work of the nervous system to a concert played by an orchestra where each musician plays in his individual manner but the global result is one commonly played melody, when suddenly the percussionist starts to beat his own time. The rhythm of the drum is more and more dominant and gradually the whole orchestra submits to it. If we envisage a discharge of a nervous cell as a decision of an alternative type (yes/no), an epileptic seizure may provide an example of radical freedom in decision-making that leads to radical de- individualisation and slavery. An epileptic seizure constitutes the antithesis of collective nervous system activities; such collectivity consists in strict correlation between the decision of an individual nervous cell and decisions made by other nervous cells; the destruction of this correlation leads to a totalistic uniformity of decision and, instead of various and individual rhythms, there exists only one common pace.

The collectivity of a decision is decreased as a given task is repeated. A new task activates the whole nervous system, which in turn activates the whole organism. It is subjectively perceived as concentrating on a specific activity, hesitating what to do. Internal tension is connected with the necessity to make a decision and is frequently accompanied by vegetative symptoms.

This statement about the participation of the whole organism in decision-making proves to be very true. As the task is repeated, however, it is increasingly easier to make a decision, and with time, the choice of an appropriate functional structure is made automatically. The whole organism does not take part in a given function but the most suitable part that can control this function. The principle of this economy of effort is valid and both phylogenetic and ontogenetic development is made according to this principle. The cells of the system specialise in specific functions and thus relieve other cells from the functions in which they are not specialised. We should remember that the whole signalling system, that is, receptorial, nervous and effectorial, developed as the result of the specialisation of a certain group of cells in the three basic functions of each cell: receiving signals, transmitting signals, and reacting to signals.

The process of specialisation does not end with phylogenesis but also exists in an. individual’s development. A child learns to walk, speak, write, etc., and activates its whole receptorial, nervous, and motor apparatus. It may be seen from the way it behaves how much effort is put into the choice of the proper form of movement and its achievement. The whole willpower is concentrated on one activity. With the course of time, the activity becomes automatic and is done without thinking, an order given to oneself to walk, speak, write, etc., and is enough to activate a complex chain of events to perform a given activity. The problem of choice and decision-making, so characteristic for the nervous system activities, is not eliminated when a given activity is automated; the activity does not activate the whole system but only that part that specializes in a given activity. In a difficult situation, an automated activity becomes a conscious one again (for example, every step made on a difficult mountain route requires careful attention and conscious decisions); the decision becomes a common one again and is no longer made by a part of the system as in the case of automated activities.

The problem of automatisation is very strictly connected with the problem of the hierarchy of decisions. Quanta, in other words, the decisions of individual neurones combining in smaller and greater complexes that are interrelated. Individual complexes specialise in specific problems, for example, in selecting signals coming to the nervous system, controlling some vegetative or motor activity, co-ordinating decisions, etc. The more complexes activated, the higher the hierarchy of decisions. Life assigns new tasks all the time, hence the hierarchy of decisions must also be constantly changed. As a new task is repeated, a given decision is lowered in the hierarchy based on the economy of functions; it activates only those complexes of neurones that are necessary to control a given task. Such is the essence of automatisation.

There are three factors that influence the style of a decision: its subject matter (programming), the speed of choice, and changeability. The subject matter obviously depends on a genetic programme coded in the nucleus of a nervous cell, but it is also dependent on the life history of a nervous cell. If it is exposed to automatic stimuli for some time, typical decisions will be formed. It will specialise in a certain type of problems and will solve them in a certain way. For instance, its subject matter may be constituted by the selection of impulses coming from the receptorial cells of the retina, and the selection will be made in a typical way according to impulses coming from neurones that are higher in the hierarchy. That is why man perceives the surrounding world differently when he is in different moods, when he has different attitudes towards the environment, or changes his interests, or type of work.

The subject matter is connected with the speed of the decision. The narrower the subject matter the quicker the decision. Nervous cells specialised in a limited number of problems can give a yes/no answer quicker than cells without any specialisation that can acquire different signals from different parts of the nervous system (for example, cerebral cortex cells or retinal system cells). We may assume that in specialised neurones answers of a quantitative type, and not of an alternative type, are dominant. The speed of a decision depends on the length of the reflex arch, that is, a decision that activates a greater number of neurones will be slower than the one that will be made over a small reflex arch. As the decisions are automated, they are made quicker. The changeability of a decision depends on the level of pervasion, that is, it depends on the repetition of a specific model regardless of the flow of signals coming from the environment. The greater the level of pervasion, the smaller the changeability of a decision. In the brain, and especially in cerebral cortex, a neurone system of a closed circuit type can be frequently met. It consists in the fact that a signal that leaves cell A after going through cells B, C, D, etc., comes back to cell A and, in such a situation, it can circulate within one system endlessly. Systems of this type increase the stability of decisions.

The above attempt to present the problem of decisions, in light of contemporary neurophysiological knowledge, obviously has the character of a labile hypothesis subject to change as we learn more about the physiology of the nervous system. And the development of such knowledge is very much conditioned by technological progress, not only because such progress stimulates new research methods but also because it allows the creation of new theoretical models that facilitate the understanding of brain activities. For example, a model of an electric train helps to understand the way a living brain works in a better way than the old model of a telephone exchange. Similarly, as in other areas of life, the principle of correlation between perception and activity is also present (the principle of a reflex arch); we perceive the world in the way we influence it, in other words, we live in a world that we ourselves create.

It would be a great misunderstanding to treat neurophysiological and psychological decisions as equivalents. The problem of decisions has preyed on the human mind probably since the moment man started to make rational observations. It is one of the key motifs of philosophical thought as well as of psychological and psychiatric considerations. Both the psychologist and the psychiatrist try to learn the motive behind a particular decision in every case they deal with; thus, the problem of motivation is very closely related to it. Every individual tries to answer such questions all the time and tries to find answers as rational as possible. The rational explanation of one’s own or someone close’s decisions does not necessarily denote the correctness of such an explanation. A man who undertakes a decision imposed on him by an order given when he is in a hypnotic trance or under the influence of subliminal signals (a method sometimes used in advertising campaigns by Western television), may find a rational motivation for his behaviour while unaware that he is under the remote control.

Some analogies appear to exist between a decision in a neurophysiological sense and a decision in a psychological sense. Let us look at some of them, as this may assist in understanding the complex problem of cognition.

Alternative and quantitative decisions, which constitute the two types of decisions made by the nervous system, in psychological life, may be compared to the choice between two opposite possibilities and to constant hesitations that are not chosen, but which create the appropriate climate for an alternative decision.

Mothers and children after selection for the gas chamber

The collective character of nervous system activities corresponds to the integration principle in psychological life; contradictory feelings, thoughts, and aspirations constitute a more or less harmonious whole that specifies a given man and is the basis of his identity. A conscious decision results from this integration, and therefore frequently also requires great effort; creating a ‘whole’ out of contradictory tendencies is by no means easy. The rejected elements do not disappear without trace. Freud deserves credit for drawing our attention to this apparently obvious fact. By his analysis of neurotic symptoms, dreams, and erroneous actions he proved the existence of the suppressed elements in our consciousness. In an obsessional neurosis, the ability to make decisions is distinctly lower due to the thoughts, actions, and phobias forced upon the patient. The fight with this strange psychological element that is rejected by the consciousness is hopeless; it may only intensify obsessive experiences. The elements that were eliminated in the selection some time in the past take their revenge now over the victorious elements. Normally, only a small part of the selection process is conscious. Although we choose and decide all the time, the majority of decisions are made outside our consciousness. Sometimes a moment of reflection comes and we wonder why we acted in such a way. In schizophrenia, we can clearly see the mechanism of conflict between two alternatives that exclude each other and require a choice. A pathological manifestation of the process of selection is initially concerned with the choice between the basic emotional attitudes. Normally such choice is made outside the consciousness; one cannot force oneself to love, hate or be afraid. In schizophrenia, one cannot control one’s feelings, but manifests a dramatic conflict between contradictory emotional attitudes, which are sometimes so strong that none wins. Inability to make a choice between basic emotional attitudes influences the patient’s entire psychological life and behaviour; this attitude constitutes the basis on which other more detailed forms of activity are built. A patient shakes hands and pulls his hand back immediately, sits down and stands up, his face shows various, sometimes opposing, feelings usually not appropriate to the situation. These are the elements that can be observed during a first meeting, and from the lack of an emotional decision, that is, the choice of a given emotional attitude appropriate in a given situation.

The collective character of decisions can also be observed in daily life. Decisions made by one person influence decisions made by another. In camp life, such a phenomenon was especially distinct. In the states of total exhaustion or during the first period in the camp a prisoner lost his ability to make choices, he did as his nearest neighbours did, and moved where he was pushed. Overcoming this state of automatisation was a necessary condition to survive. The ability to make decisions is an absolute basic attribute of life. Help offered by a colleague, a friendly word, etc., gradually brought back this ability. The one who offered help became a model in decision formation; ‘I want’ gradually developed from a collective ‘we want’.

The problem of automatisation, so essential for the economy of nervous system activities, points to a well-know fact that nothing can disappear without trace in nature, all decisions are recorded in nervous cells and influence later decisions. Due to this fact, the later decisions are easier; instead of activating the whole nervous system, they activate only the part that is essential in performing a given task. We speak of automatisation in a psychological sense when certain repeated activities cease to activate the consciousness and the appropriate decisions are made outside the threshold of consciousness. This process is essential in all training; it also constituted the basis of the training of SS-men.

We may now attempt an answer to the question that constituted the impulse for the consideration about decisions; to what extent we are responsible for our deeds. Although the problem of responsibility is not a medical but an ethical, legal, and philosophical one, it is interesting for a doctor as a human problem, although his profession is not that of a judge assessing whether a given decision was right or wrong, or to what extent man is responsible for what he does.

A pregnant woman and her children arriving at the Auschwitz concentration camp

Of the two alternatives that one is responsible for either conscious decisions or that one is responsible for all his decisions, the second alternative appears more natural from a biological perspective. The first alternative refers only to a small area of life where decisions are made and full awareness of the decision is required as a condition of assuming responsibility. However, when we consider not only a critical moment but also the whole life of a given man, then we may be able to find a point in his life history in which the decision of a particular deed had its origin but later disappeared from consciousness because of suppression or automatisation. At the critical moment, the action was made impulsively or automatically without the participation of ‘the free will’, and the action itself, however, shows that something that constitutes the essence of the action was inherent in the one who performed it. What is more, it is stronger than a conscious decision that constitutes a surface layer of our life, it is created when we are first confronted with a new situation, whereas a subconscious decision is a manifestation of all the inherent and frequently repeated elements of our life. This would be a reversal of the principle qui dormit, non peccat. As the saying ‘in vino veritas’ suggests, alcoholic intoxication – as well as dreams – expose the true picture of man better than his conscious states, when conscious decisions can sometimes conceal the essential truth about his life. As might be expected in the conditions of the camp life, this surface veneer of everyday normal life was easily removed; man was left naked. In this sense, the concentration camp constituted a test of one’s human values.

The third variant of the situation on the ramp includes the most numerous group of prisoners who were not aware of their future fate. SS-men did not even try to disclose the truth. That is why prisoners behaved exceptionally well. Some prisoners may have sensed the strangeness of the situation and had a premonition about their destiny. Their common sense, however, opposed those intuitive speculations and forced them to deal with present and real matters such as getting water, food, worrying about the family, belongings, planning the nearest future, etc. In such a circle decisions were formed; they did not differ from the ones made previously, before imprisonment. They might probably have been different if the future was known.

Thus the situation was similar to one with which everyone is acquainted in his everyday life. We do not know our future but challenge it with our decisions in the hope that it will turn out as we want it to be. A permanent projection into the future is an attribute of life. A decision constitutes the point where the future becomes the past; a plan of action is chosen out of many alternatives and its implementation has started. The choice alone is a step into the future, and shows the path we have to follow. The situation on the ramp shows the delusiveness of this path; fate can cut it off at any moment. The fact we do not know our fate and that ‘man proposes but God disposes’ obviously does not weaken our tendency to plan the future since such a tendency is an essential factor of life. In depression, the life dynamic is weaker; consequently, the tendency to plan the future is also weaker; the future appears to be gloomy, and decisions become extremely difficult. Normally, however, man thinks of his future even in the worst moments of his life and he does not lose the ability to make decisions, due to which he is able to conquer the future.

The three variants of the situation on the ramp presented here do not include all the possibilities connected with the complex problem of decision- making; through their intensity, however, as in the case of many other camp situations, they help us to better understand the problem of decisions.